Tuesday, August 28, 2007

Burnin' Love

I get about 6 medical journal delivered to my office each month. Quite honestly, many of the articles deliver little in the way of clinical impact, with hefty doses of basic science and reiterations of previous studies provided as filler. Occasionally, though, the title of an article will be enough to grab my attention and pull me straight in. Such was the case with a recent article in Surgical Endoscopy, authored by a large cohort of investigators from Napoli, Italy --- The Prevalence of Sexual Behavior Disorders in Patients with Treated and Untreated Gastroesophageal Reflux Disease.

OK. This can lead to all sorts of interesting questions. Such as, who exactly came up with the idea of studying sexual behavior in patients afflicted with GERD? And, does the "heartburn" associated with unrequited love leading to lack of sexual activity qualify one to participate in this study?

From the abstract:

Methods Upper GI endoscopy and 24-h ambulatory pH testing were performed to confirm GERD in symptomatic patients. GERD patients completed an anonymous questionnaire on sexual life before and after medical or surgical treatment.

Results Compared with HC (healthy controls), untreated patients with GERD (gastroesophageal reflux disease) showed more frequent difficulty in attaining orgasm and painful intercourse. GERD patients after surgical treatment had significantly more difficulty in attaining orgasm, while after continuous medical treatment GERD patients compared with HC had significantly more difficulty in attaining orgasm, higher painful intercourse, lower sexual desire, and perceived more frequently that the partner was unhelpful. When compared with untreated conditions, GERD patients after surgical treatment had a significant improvement in attaining orgasm and in painful intercourse but a significant decrease in sexual desire, a lower satisfaction with their sexual life, and a higher prevalence of an unhelpful partner, whereas GERD patients after medical treatment had a decrease in all indices of sexual behavior.

Whoa! Talk about putting the kibosh on the horizontal bop! Pouring cold ice on the situation. Turning the hose on the dogs. You get the point.

What is particularly interesting to me is that even patients who had what we would consider to be optimal treatment --- either an antireflux procedure or proton pump inhibitor therapy --- had a worse sense of sexual quality of life than normal control subjects. Surgical therapy did seem provide a slightly better result, but this was a relatively small study (111 GERD patients and 32 controls). And, not to be indelicate, what exactly does an "unhelpful partner" mean --- I mean, really, what kind of questions were in this survey?!

"Burning Love?" Sounds like that's sort of out of the question, if you look at this study. I suppose that it makes sense, if you look at GERD in the context of other medical problems that cause patients to have a diminution in their sense of overall well-being --- inflammatory bowel disease, coronary artery disease, diabetes, malignancy, just to name a few. If you spend a fair number of your nights sitting up in an easy chair fighting a burning sensation in your chest and throat that feels like somebody poured battery acid down your esophagus, I think it's fair to assume that getting your groove on isn't high on your priority list.

Sort of makes you wonder about one of our former presidents, a famous GERD sufferer, and what his sexual appetites would have been like if he wasn't held back by reflux....